Intensive Motor Rehabilitation With Technology for Patients With Central Neurological Disease

The Functional Independence Measure (FIM), which measures independence in daily functioning after stroke. The FIM consists of 18 items designed to assess to what extent a person needs assistance in performing activities of daily living safely and efficiently. The activities consist of a number of basic skills related to self-care, pelvic floor function, transfers, gait, communication and social abilities. The FIM has acceptable reliability and has been found valid in people with stroke.

Min: 13; Max: 91; Higher = better

Spinal Cord Independence Measure (SCIM), an assessment of achievements of daily function of patients with spinal cord lesions. The scale consists of 19 tasks organized in 3 subscales: self-care, respiration and sphincter management, and mobility. The SCIM is valid and reliable.

Min: 0; Max: 100; Higher = better

The Canadian Occupational Performance Measure (COPM), is an evidence-based outcome measure designed to capture a patient's self-perception of performance in everyday living, over time. This outcome can be used in both study populations.

Min: 1; Max: 10; Higher = better

EQ-5D-5L, measures quality of life at five levels of health (mobility, self-care, daily activities, pain/discomfort and anxiety/depression). From this, a weighted health index can be calculated for an individual or population. This scale can also be used for both populations.

Min: 1; Max: 100; Higher = better

Goal Attainment Scaling (GAS), is an individualised evaluation method. It is scored on an ordinal 5-point scale, which captures a person's individual treatment goal and is scored afterwards on the achievement of that treatment goal. The GAS can and will be used for both stroke and spinal cord injury.

Min: -2; Max: +2; Higher = better

The fatigue severity scale (FSS) contains 9 questions assessing the perceived severity of fatigue symptoms in the past week in various daily situations. The patient indicates the extent to which fatigue determines functioning. Again, this will be used for both stroke and spinal cord injury.

Min: 9; Max: 63; Higher = worse

During the intervention the Borg Rating of Perceived Exertion Scale will be completed to after every therapy block to assess subjective experiences of the patients during physical load.

Min: 6; Max: 20; Higher = worse

The 6-minute Walk-Test (6MWT) is used to measure functional capacity. The maximum distance the patient can cover within 6 minutes is measured.

The action research Arm Test (ARAT) is an observational measure to assess upper extremity performance (coordination, dexterity and functioning), including 19 items. Task performance is rated on a 4-point scale, ranging from 0 (no movement) to 3 (movement performed normally).

Min: 0; Max: 57; Higher = better

The Fugl-Meyer Assessment (FMA) is designed to assess motor functioning in upper and lower limbs, in patients with post-stroke. Patients are assessed on 50 test items and on an ordinal 3-point scale.

Min: 0; Max: 100; Higher = better

The functional Ambulation Classification (FAC): is a functional walking test that evaluates ambulation ability. This 6-point scale assesses ambulation status by determining how much human support the patient needs when walking, whether or not they use a personal assistive device.

Min: 0; Max: 5; Higher = better

The 10 Meter Walk Test (10MWT) measures the time needed for a person to walk 10 meters. It is used to determine functional mobility and gait.

The Stroke Self-efficacy Questionnaire Evaluate individuals' confidence in carrying out activities of daily living.

Min: 0; Max: 60; Higher = better

Through this questionnaire, health economic data are surveyed to estimate direct and indirect costs that participants have due to their condition.

The following types of resource use will be collected: primary care, emergency visits, inpatient stays, outpatient services, medication, transport costs, the estimation of the amount of informal care, days away from work, and social benefits (e.g. sickness leave payments).

Using a therapy diary that the investigators ask patients to fill in every time they have been to the physical therapist/psychologist. On a monthly basis, these records are requested via mail.

Structured therapy diaries will document how the intervention is delivered, including session duration and the content of the of exercises.

Semi-structured interviews with patients and therapists will assess therapy quality, perceived benefits, relevance, satisfaction, and barriers to implementation, as well as expectations for sustainability. Therapists will reflect on adaptations made.

Observations will deepen understanding of content and delivery: 14 participants will be observed during sessions using a structured scheme. Each therapy type (upper/lower limb, with/without technology, cardiovascular fitness, goal-oriented training, self-management) will be observed weekly over 3 weeks, totaling 6-7 hours per participant per week. Observations will help interpret outcome variations across settings.